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Diabetes Evaluation

Take this test to see if you are at risk for having diabetes. Diabetes is more common in African Americans, Latinos, Native Americans, Asian Americans, and Pacific Islanders. If you are a member of one of these ethnic groups, you need to pay special attention to this test..

1. How old are you? *

2. Are you a man or a woman? *

3. If you are a woman, have you ever been diagnosed with gestational diabetes? *

4. Do you have a mother, father, sister, or brother with diabetes? *

5. Have you ever been diagnosed with high blood pressure? *

6. Are you physically active? *

7. Refer to the weight chart below. Which column do you fall under? *

Height	Weight (lbs.)
4' 10"	118 or less	119-142	143-190	191 or more
4' 11"	123 or less	124-147	148-197	198 or more
5' 0"	127 or less	128-152	153-203	204 or more
5' 1"	131 or less	132-157	158-210	211 or more
5' 2"	135 or less	136-163	164-217	218 or more
5' 3"	140 or less	141-168	169-224	225 or more
5' 4"	144 or less	145-173	174-231	232 or more
5' 5"	149 or less	150-179	180-239	240 or more
5' 6"	154 or less	155-185	186-246	247 or more
5' 7"	158 or less	159-190	191-254	255 or more
5' 8"	163 or less	164-196	197-261	262 or more
5' 9"	168 or less	169-202	203-269	270 or more
5' 10"	173 or less	174-208	209-277	278 or more
5' 11"	178 or less	179-214	215-285	286 or more
6' 0"	183 or less	184-220	221-293	294 or more
6' 1"	188 or less	189-226	227-301	302 or more
6' 2"	193 or less	194-232	233-310	311 or more
6' 3"	199 or less	200-239	240-318	319 or more
6' 4"	204 or less	205-245	246-327	328 or more
	Column A	Column B	Column C	Column D

What is your zip code? (Optional)

Enter the text you see in the security image: